Fruit juice is not ‘more equal’ when it comes to sugar and public health

Fruit juice may seem healthy, but its concentrated sugar and lack of fibre warrant the same front-of-package warning as other sugary beverages.

Nosiphiwo Nzimande and Sameera Mahomedy are public health researchers at Priceless SA (SAMRC/Wits Centre for Health Economics and Decision Science), Wits School of Public Health. Susan Goldstein is an associate professor, public health specialist, and managing director of Priceless SA. Yolanda Radu is a senior legal and policy researcher with a focus on public health, governance and social justice.

Decades after its publication, Animal Farm by George Orwell remains strikingly relevant for its reflection on how systems evolve. One of its central insights is that even well-intentioned systems benefit from ongoing reflection to ensure they continue to serve their original purpose.

This lesson offers a valuable lens for modern policymaking. At its best, policy is a collective effort, balancing interests while staying grounded in evidence and public good. South Africa is on the brink of a major public health milestone through the finalisation of regulations introducing front-of-package warning labelling (FOPL) on unhealthy foods and beverages. FOPL is a major step forward in helping consumers make informed choices and in addressing the growing burden of diet-related diseases.

Within this process, there is an important opportunity to ensure that the principle underlying the regulations is applied consistently across all products, including 100% fruit juice. Doing so will help ensure that foods and beverages with comparable sugar content are treated in the same way, enabling consumers to make truly informed choices. It would also strengthen alignment across South Africa’s broader nutrition policies.

The Health Promotion Levy has made meaningful progress in reducing sugar consumption. Extending this levy to beverages exceeding 4g of sugar per 100ml (such as fruit juices) and requiring a FOPL label on all high-sugar items – including 100% fruit juice – would strongly reinforce this progress.

FOPL has emerged as one of the most effective public health tools to help consumers make informed dietary choices by providing clear, visible warnings about high levels of sugar, salt, and fat.

Yet, despite its promise, there appears to be an important area for reflection in the draft FOPL regulations. As it stands, the regulations do not extend to 100% fruit juice. This exclusion is noteworthy given that 100% fruit juice also contains high amounts of sugar , which is recognised by the World Health Organization as contributing to adverse health outcomes.

One hundred percent fruit juice is marketed and consequently perceived as “healthy”. It is advertised as natural, vitamin-rich and wholesome, thus benefiting from a powerful “healthy” narrative that shapes consumer beliefs .

A growing body of evidence indicates that despite some benefits, fruit juice still contains a lot of sugar that affects the body in the same way as sugary sweetened beverages such as cool drinks.